脳主幹動脈の動脈硬化がびまん性かつ高度で，複数の抗血小板薬投与によっても再発を繰り返す脳梗塞—繰り返す脳梗塞例に対する対応

Cerebral Infarction with Diffuse and Severe Atherosclerosis of The Main Cerebral Artery and Recurrent Infarction Despite Multiple Antiplatelet Agents: Management for Acute Stroke Patients

脳梗塞治療で用いることができる抗血小板薬としてプラスグレルが効能追加となり，内科的治療の幅が広がることが期待される。その一方で，いまだ内科的治療に抵抗性で，症状悪化をきたす症例は散見され，次の一手を考えながら治療に臨むことはよくあることである。脳神経内科医としては，抗血小板薬を含めた内科的治療を適切に行えるようにすること，外科的治療への移行時期を知ることが求められている。本論では実際の症例を交えながら，再発を繰り返す脳梗塞例への対策を考えたいと思う。

Abstract

The recent approval of prasugrel will expand the choice of medical treatment. Prasugrel, as a platelet inhibitor, was approved for the management of cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome in 2009. In 2021, it was also approved for use in patients with ischemic stroke. However, there have been cases of patients showing resistance to medical treatment and, therefore, worsening symptoms. It is important to approach treatment while considering the next step. Physicians should be aware of medical treatment choices, including the use of antiplatelet drugs, as well as the appropriate timing to shift to surgical treatment when necessary. In this paper, clinical practice options and guidelines will be considered.